A Challenge to Document My Journey

A few messages have been hitting me recently...

"No one ever got anywhere except through hard work."

"Fake it till you make it... cuz we're all faking it."

"Don't just write... Document"

These come in different forms and from different speakers... I am kinda paraphrasing and the sources are actually marketers... Gary Vee and Mitch Miller. The message underlying this note is that there is a benefit to the world if I just acknowledge that I am who I am and what I'm going through.

Whether it's interesting to anyone else is up to them.

So, this is my 'no apologies - apology': I am going to be myself for a little here. You may like it or not, you may feel free to disagree, or agree.

Oh, and I certainly do care... but I think there's something worth doing here so I will.

Thanks for stumbling on this.

Yours,
Ed Kaine, OT, RFT

P.S. Just because it is going to be me documenting this process, don't worry, it's still going to be useful... at least in some way to some people.

P.P.S. I imagine that it will have a certain level of self censorship... but that's a part of me too.

Introduction to Functional Therapy Magazine.

Ed Kaine, Publisher of Functional Therapy Magazine introduces the theme of the magazine.

There are a few ideas here:

1. It's time to lead or be left behind.
2. Function is very fashionable... because it works.
3. The CRAFT Model is a holistic model that will help all health care to provide better care.
4. Many disciplines are becoming more functional and Occupational Therapists must work to lead this. It is our responsibility to guide the world to the optimal health we seek.

I have a significant number of people who are interested in helping define function and health care for the future but I want to open it up to anyone from any discipline to join us and help shape the future of health care.

Please Like us on Facebook https://www.facebook.com/FunctionalTherapyMagazine and contact us through facebook if you'd like more information or to contribute an article or promote your point of view.

Yours,

Ed Kaine, OTR/L, RFT
Publisher of Functional Therapy Magazine

P.S. Please check out www.FunctionalTherapy.org for all the latest articles in health care and therapy topics that we and our readers can find.

The Scientific Method Within the Treatment Session.

Functional Therapists see new and unique cases every day. The most successful therapists continue to conduct mini-experiments and expect to see rapid results. If patients are improving within the sessions and progressing session to session we can know we're making an impact. We know it empirically... 

Definition of Empirical:

1. originating in or based on observation or experience
2. relying on experience or observation alone often without due regard for system and theory
3. capable of being verified or disproved by observation or experiment <empirical laws>

Every treatment should result in positive change. That simple standard requires that we pay attention, measure and change our approach when things aren't working.

Paying Attention

We look, feel and hear things as we're working with and helping someone. We pay attention and we remember. The observation is improved by experience. The more tools and experiences we bring to our helping relationships help us stay observant. Functional Therapy and Occupational Therapy training gives us a tremendously broad toolkit to practice from. Experiencing illness and injury through our patients gives us a unique perspective as we develop in our careers. Beyond this, experiencing illness ourselves is a powerful educator (as I can attest). All of this helps us to really focus on our patients.

Measurement

If you want to improve something it is crucial to measure it. Attention and remembering is partly a form of measurement. Finding quick ways to compare initial status to post treatment status is important if you're going to help someone improve. It also becomes important that you help your patient notice improvements. Patient compliance will increase as patients notice improvements. We have so much we can bring to people and we owe it to them to help them see the benefits. Some things may be uncomfortable but there is a tangible reason for doing what we do, the measurable benefit. We shouldn't keep this to ourselves, we want to involve our patients. Also, we must measure functional changes. I'm a big fan of the DASH, (Disabilities of the Arm, Shoulder and Hand). This measure rates the difficulties with various functional tasks.

Changing as Needed

The tremendous toolkit of skills Functional Therapy  and Occupational Therapy training I mentioned before is not only useful for helping observation, it is absolutely critical for the flexibility when we need to change things. If something is not working you need to change it. When we get into typical patterns of treatment we may miss the optimal treatment for the patient. Certain treatments are very effective in many people and often we can get close to the ideal when we deviate from the typical. There are sometimes barriers to going after the root cause of the problem but often we can find solutions that help.

In short, we need to rely on Attention, Measurement and Change to follow what we are learning empirically about the patient. Functional Therapy is an applied science. Every session is a series of experiments where the results happen very rapidly. If, as a therapist, you hold to the goal of making positive change within the session and carrying that progress through from session to session. We want our patients to get through their difficulties quickly and back to their lives and functioning.

Good luck with all your efforts to help your patients.

Yours,

Ed Kaine, OTR/L, RFT
Publisher of Functional Therapy Magazine

FunctionalTherapy.org is Live and Free!

Functional Therapy Magazine wants you to know about www.FunctionalTherapy.org. We have put together a selection of the latest and best articles about health and wellness. Please check it out. We are really excited about it.

Some fun features... you can like articles (that's nothing new) but you can save those articles to your reading list. You can share them. You can search for your particlar interests and link in health topics and articles you find first. Our members are adding articles as we speak... and it's all free.

These functions will make it easy to share the latest information on health and wellness. I think you're going to love it.

Yours,

Ed Kaine, OTR/L, RFT
Publisher of Functional Therapy Magazine

Thinking Bigger!

I love the great work that Occupational Therapy can do for humankind and the world. We have an important perspective on Health Care and we can do so much more to advance the goals of OT.

Recently, I published a book, it is a parable about acceptance and resignation. It is about finding joy in the face of obstacles. I believe it has a message for everyone. It is on $0.99 promo on Amazon currently (it's at http://www.amazon.com/recognition-of-a-prisoner-ebook/dp/B00ANFD1TE/ref=sr_1_1?ie=UTF8&qid=1360215629&sr=8-1&keywords=recognition+of+a+prisoner).

This was a little of me thinking bigger but really not what I mean. Occupational Therapy and Functional Therapy are such powerful ideas. It's time for me to do more with them.

If you would like to be a part of it contact me at EdKaine@FunctionalTherapist.org and lets see how far we can go.

Yours,
Ed

Top 5 Differences between Acute Care and Outpatient OT

Top 5 Differences between Acute Care and Outpatient OT

 

Currently I am making a transition to Outpatient. I have done a little outpatient OT in the past and 17 years of Inpatient and Acute Care from Pedi to Geriatrics, Neuro to Burns.... Outpatient is a different animal.

 

The main differences are:

1. Scheduling
2. Billing and Coding
3. Documentation
4. Patient Type (Acuity and Diagnosis))
5. Outcomes Measurement

Scheduling

In Acute Care there are so many factors that can influence your time. Patients are ill, they leave the floor for testing. In our case we made an extensive list of patients that the therapists would see. If the patient was unavailable you may check back, otherwise you proceed.

 

In Outpatient there is a much more regimented pattern. Blocks of time are in 1/2 hour for treatments and 1 hour for evaluations. It is possible to get the patient from the waiting room, see the patient and write the note in a 1/2 hour but just barely. If there are any delays to the schedule it is very difficult.

 

There would surely be ways to make the process for both more efficient.

 

Billing and Coding

In Acute Care we are paid by DRGs or Diagnostic Related Groups. Essentially, if some one has a pneumonia with no modifiers you get one rate. There is a tremendous benefit to this if your facility recognizes the benefits of rehab for decreasing Length of Stay - LOS. The more Rehab, the shorter LOS, the more money for the facility. However; many places did not figure this out and Acute Cares may be somewhat understaffed as a result.

 

In Outpatient we are tied to the myriad Insurance Company Demands. The history of Outpatient includes a little bit of fraud, so... everyone suffers and a lengthy process to justify treatment ensues. Now, there were a few bad apples but everyone is required to dedicate a lot of time to making sure the payers believe rather than treating the patients. Necessary evil? Or unfortunate consequence of a few bad apples. Anyway, we document ICD9 codes, E-Codes and Now G-Codes, just to make sure it's okay.

 

Authorization in Outpatient is an unfortunate waiting period after the evaluation while the Insurance Company decides if you merit treatment. Usually you do, but certain insurances take more than a week to tell you. Unfortunately, that week can be the most painful of weeks.

 

In our facility Acute billing is electronic for the therapists but only because I wrote the database that did it. In Outpatient it's on paper and gets added by administrative support people.

 

Documentation

In Acute Care many facilities have gone to Computer Based systems, we have. We write an Eval with separated data in a database. This generates as report that can be pasted into Cerner. Later this year we will be going to Epic which may have a lot of clicks and limited reproducibility but we shall see.

 

In Outpatient there are significant concerns due to the billing and coding process and the need to have Doctors specifically sign the plan of care. Also, an authorization must be sent with the Doctors reviewed POC to the insurance company to seek the Authorization I mentioned above. 

 

Patient Type (Acuity and Diagnosis)

In Acute Care therapists see the sickest of the sick. Patients who need to stay in hospital need to have a lot of care given to them. Also, the culture of hospitals often leads to patients spending much too much time in bed. Bed rest is terrible for most conditions (maybe preterm labor can justify it and the others are for very short periods of time, like just after a procedure).

 

In outpatient, the great majority are ambulatory. They have a few focused injuries and if the Doctor ordered care for any particular one we can work on it. The body and function is divided and specialists are called for a careful review of the body part the Doctor referred for. I have an inclination to want to review and treat the whole person. In this case sometimes I can't.

 

This doesn't make much sense sometimes as we are trying to get people better and more functioning. I think this is the challenge to expand the care of patients to their ultimate needs rather than what they remembered to ask for in the Doctor's office. Also, with the minimal recognition of OTs roles many Shoulder and Elbow patients are referred to PT and not OT. If we're going to go by that unfortunate divide the body system we should at least adhere to it.

 

Outcome Measurement

In Acute Care this is currently pretty limited. The DRG system has devoted resources towards monitoring Length of Stay or LOS. The focus is on getting people out, back home and not returning within 30 days for any reason. The measurement around these values is somewhat patchy but can be done with effort.

 

In Outpatient there has been a lot more effort on developing and using outcome measures. Currently, I am writing a tool to help administer, score and report on the DASH - the Disability of the Arm, Shoulder, Hand Scale. This scale nicely gives a score out of 100. It looks like a disability score but not officially. It has a lot of great ideas for helping guide the functional components of treatment.

 

I think the outcomes measures would be a big help.

 

Summary

Overall there are many key differences between acute care and outpatient OT. There are several others and I'd love to hear your ideas and experiences about them in the comments below. 



The CRAFT Model - Dynamic Variations of a Holistic Model - Part 5

Restoring Balance To The Platform

In the preceding scenarios we reviewed the sources of imbalance, now we will discuss a central principle of Functional Therapy, supporting function.

Let's revisit the model as it is unbalanced by a deficit in abilities. No matter the ability pillar we can upset the balance of functions. Most often healthcare professionals work to restore the physical body, in fact, most of medicine is working towards addressing physical complaints, symptoms and problems. The deficits from mental, social and motivational impairments can lead to similar imbalances.

Let's return to the person with the deficit of the motivational pillar. This might have been caused by a depression or perhaps the depression is caused by the imbalance of functions; by not performing a balance of functions you can lose your motivation. Consider the lack of balanced function as a risk for other deficits.

The CRAFT Model is a snapshot of the status of an individual; consider personal history an elucidation of which caused which, in other words we get to find out if it was 'the chicken or the egg'. I wish to popularize the idea that an imbalance in functions could lead to other deficits any of the other areas. 

In order to most effectively help a person we work to restore balance to function. In this case we depict an external support, possibly a social support, to help restore balance to the platform of functions. 

"The worst place to decide whether to get up and get dressed is in bed." - Unknown  

By supporting a person doing functional things we allow them to use their mental, social, physical and motivational abilities in  functional way. In short, "the more you do, the more you can do." They also engage with their physical environment, social supports, temporal situation and consider their cultural background more deeply. The Functional Therapist and Functional Therapy Associate works to assess the limitations and then seeks to expediently restore balance. The ability to call on the whole model and more gives Functional Therapy its strength.

OTs and Functional Therapists might occasionally find themselves off the course of purely a functional or occupational approach to care; the CRAFT model seeks to help get us back to the value of doing functional things in therapy. We must consider the paths of remediation and compensation as ways to restore function along with external support and means to seek balance in function as a reasonable jump off point for a return to living.

Thank you for reading.

Yours,


Ed Kaine, OTR, RFT
President of the American League of Functional Therapists, LLC

P.S. If you would like to join our emailing list and get updates and newsletters about ALOFT and the International LOFT please email ALOFTMail@FunctionalTherapist.org and enter "Subscribe" in the subject line.